Healthcare Provider Details

I. General information

NPI: 1588754287
Provider Name (Legal Business Name): ANGELA WATKINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 TELFAIR ST
AUGUSTA GA
30901
US

IV. Provider business mailing address

PO BOX 2344
AUGUSTA GA
30903-2344
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-0600
  • Fax: 706-922-0603
Mailing address:
  • Phone: 706-922-0607
  • Fax: 706-396-1461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number003237
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003237
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: